Senior management’s understanding of and response to climate goals in healthcare: a qualitative study in a Swedish hospital

Abstract

Background: Healthcare is a major contributor to greenhouse gas emissions, and sector-specific policies and goals are recommended as governance tools. Despite leadership playing a critical role in reducing emissions, there is limited empirical research on how healthcare managers perceive and navigate climate goals and actions. Objective: To explore how members of a hospital’s senior management team understand and respond to climate goals. Design: Qualitative study design, semi-structured interviews were conducted, and data were analysed thematically. Setting: A hospital in Sweden. Participants: Members (n=15) of the hospital’s senior management team. Results: Five themes were identified. Senior managers recognised the importance of climate goals (theme 1), but their understanding of these varied—from perceiving them as concrete and actionable to abstract and irrelevant at the departmental level (theme 2). Climate goals were described as both visible and invisible (theme 3), and as both in alignment and in competition with other organisational goals (eg, patient safety, budget constraints) (theme 4). There was a common understanding that they, and the hospital, could do more to reduce emissions but knowledge gaps, limited resources, monitoring challenges, as well as systemic constraints, challenged advancement (theme 5). These dynamics led to two co-existing patterns of responses: a virtuous cycle of climate action and a vicious cycle of climate inaction in which uncertainty prevailed. Conclusions: Climate goals can act as both catalysts and inhibitors to climate actions in hospitals, depending on how they are understood and operationalised by senior managers. Policymakers and healthcare system leaders must address the uncertainty surrounding climate goals to advance climate action.